And still the least talked about.
This leaves women waiting for vasomotor symptoms (because that's pretty much all media, marketers and the medical community talk about) while waking up in their mid-to-late 40s or early 50s surprised by heavy (and/or irregular) bleeding and immediately assuming something is seriously wrong.
While it is true that many women will experience vasomotor symptoms (hot flashes/night sweats) as a result of fluctuating hormones in the final year of perimenopause (the 12 period-free months leading up to menopause,) the most common perimenopause experience (due to fluctuating or declining progesterone) is irregular bleeding: shorter periods, longer periods, sometimes lighter periods and often, heavier periods.
When women are unaware of this probable change, it causes concern. Women sometimes believe they have a serious health condition, like cancer, or head to the emergency room, which can sometimes be a frustrating or dismissive experience.
What you need to know about heavy bleeding:
Perimenopause is defined by age and hormone fluctuations.
Perimenopause is a time in a woman's life when her body is preparing for menopause (end of ovulation/reproduction/menstruation.)
Generally speaking, in perimenopause, the ratio of estrogen-to-progesterone can become mis-matched; estrogen can be high or higher, and progesterone low. When this happens, the first change women might experience is changes to their monthly periods: length & flow.
This is a common experience, but it isn’t commonly talked about. In fact, according to the International Menopause Society, 70% of gynecological visits are due to heavy bleeding!
I am NOT suggesting you don’t consult your health team to discuss any concerns regarding bleeding. In fact, that is the BEST thing to do—if for no other reason than to rule out something serious!
I AM suggesting conversations about irregular bleeding are important to raise more awareness about perimenopause so that women might be less worried, more prepared and know what to expect.
What is the definition of a "heavy" period?
Most women don’t know what a “normal” period bleed should be (I mean, who was ever taught that in school!?).
The most common amount of menstrual flow is about 1-2 Tbsp (15-30mL) per period, and a period that lasts 4-6 days.
For reference, each soaked sanitary product (tampon or pad) contains about 5mL (1 tsp) of blood.
That means it is normal to soak 2 to 7 normal-sized sanitary products PER PERIOD. Not per day.
A “heavy period”, which in medical terms is called “menorrhagia”, is defined as >80mL menstrual blood lost per period. This is the equivalent of 16 soaked sanitary products (tampons or pads) per period, or a period that lasts longer than 7 days.
More below ⬇️
3 KEY things to address heavy bleeding:
The Ibuprofen Protocol + Supplement your IRON: Dr. Jerilynn Prior of the Centre for Menstrual Cycle and Ovulation Research in Vancouver, advises women with heavy flow to keep track of their experience, to take ibuprofen (200 mg every 4-6 hours which decreases flow by 25-30%), to treat blood loss with extra fluid and salt and to increase iron-rich foods, and to take a high-quality iron supplement.
The birth control pill vs. what else? First, if the birth control pill is your contraception method of choice, it may be helpful in managing your periods. However, you need to know you have more options than the pill. Speak with your doctor about the potential benefits of progesterone therapy or an IUD (hormone-based intrauterine device), and know that some women choose or require both.
Consult your physician regarding ANY concerns about bleeding--if for no other reason than to rule out other serious health concerns. This includes:
when bleeding is so heavy it requires a new pad every hour
bleeding that lasts more than two weeks
ANY bleeding after menopause (12 months after your final period.)